الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
96
SUMM~RY AND CONCLUSION
In late renal failure. hyperkalemia is common.Moreover
about 2 % of patients in e~ly chronic renal failure
may suffer from troublesome hyperkalemia.
Most patients with chronic renal failure display glucose
intolerance, which is referred to as wUremic Pseudodiabetes
·, the fall in plasma glucose in responce to insulin
injection is blunted in those patients. suggesting peripheral
resistance to the action of insulin, particu1aryin
skeletal muscles.
The plasma concentration of thiamine (a water soluble
81 vitamin) increase slightly with renal failure and
decrease with haemodia1ysis. This decrease amounts to 10%
be,-ause of protein binding.
Pyruvic acid tends to accumulate in tissues in severe
thiamine deficiency due to defect in Kreb’s cycle in which
thiamine pyrophosphate is a co-enzymes.
Serum potassium rises with acidosis that results
This study is carried on 24 patient~. 14 are males and 10
are females suffering from chronic renal failure and not
diabetics, (Diabetes Mell it us),
97
Patients were subjected to chronic regular haemodialysis.
three setting per week.
Blood glucose. serum potassium and serum pyruvic
acid were determined in those patients before and after
hemodialysis in one setting and also determined after
anthor setting during which insulin and glucose were given
Also these parameters were estimated after a third setting
during which insulin. glucose and thiamine injection were
given.
We found that the decrease in ”blood glucose after
hemodialysis is not significant and serum pyruvate showed
insignificant increase.
Potassium level showed significant decrease after
hemodialysis.
Blood glucose and serum potassium level showed significant
decrease after hemodialysis when giving glucose
infusion and insulin a finding which means that:-
1- Suppression of hepatic glucose production by insulin
as well as stimulation of hepatic glucose uptake is not
impaired.
2- Potassium lowering effect of insulin is not impaired in
patients with chronic renal failure.
98
Serum pyruvate level~ showed significant increase and
this means that cellular uptake of glucose is not impaired
and the enzyme system of Embedell’MaYffrhofJ is not affected
by uremia The rise of serum pyruvate could be attributed
to local anoxia in the tissues that delay further meta:-
bolism of pyruvate in kreb’s cycle.
After administration of glucose. insulin and thiamine
blood glucose level and serum potassium level showed
insignificant decrease and increase respectively but serum
pyruvate showed significant decrease. This could be explained
by the effect of thiamine on the activation of the
enzyme pyruvate dehydrogenase and further metabolism of
pyruvic acid.
from these results we may conclude that :-
1- Insulin exposure is not blunted.
2- Potassium transport is helped by addition of
and insulin.
glucose
3- Thiamine deficiency resulting from dialysis may
to increase of pyruvic acid leading to acidosis
this may be corrected by addition of thiamine to
patients.
lead
and
the
99
4- Serum pyr”vate determination in every setting during
haemodialysis is essential to detect thiamine defficiency.
5- This study may be of value in selecting patients under
haemodialysis who will benefit from kidney transplantations
(tve response to therapy) from those who will
not benefit much from transplantation (-ve response to
therapy).
6- So further study is suggested in patients with terminal
renal failure to see if the enzymes of Kreb’s cycle
are still working or not so giving the conclusion number
5 it’s importance, (uremic coma).